American Journal of Gastroenterology最新文献

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Incidence, Predictors, and Outcomes of Clinically Significant Post-Endoscopic Retrograde Cholangiopancreatography Bleeding: A Contemporary Multicenter Study. 内镜逆行胰胆管造影术后临床重大出血的发生率、预测因素和结果:一项当代多中心研究。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI: 10.14309/ajg.0000000000002946
Kirles Bishay, Yibing Ruan, Alan N Barkun, Yen-I Chen, Andrew Singh, Lawrence Hookey, Naveen Arya, Natalia Causada Calo, Samir C Grover, Peter D Siersema, Nirav Thosani, Saeed Darvish-Kazem, Deborah Siegal, Sydney Bass, Martin Cole, Yang Lei, Suqing Li, Rachid Mohamed, Christian Turbide, Millie Chau, Megan Howarth, Shane Cartwright, Hannah F Koury, Tamim Nashad, Zhao Wu Meng, Alejandra Tepox-Padrón, Ahmed Kayal, Emmanuel González-Moreno, Darren R Brenner, Zachary L Smith, Rajesh N Keswani, B Joseph Elmunzer, Sachin Wani, Ronald J Bridges, Robert J Hilsden, Steven J Heitman, Nauzer Forbes
{"title":"Incidence, Predictors, and Outcomes of Clinically Significant Post-Endoscopic Retrograde Cholangiopancreatography Bleeding: A Contemporary Multicenter Study.","authors":"Kirles Bishay, Yibing Ruan, Alan N Barkun, Yen-I Chen, Andrew Singh, Lawrence Hookey, Naveen Arya, Natalia Causada Calo, Samir C Grover, Peter D Siersema, Nirav Thosani, Saeed Darvish-Kazem, Deborah Siegal, Sydney Bass, Martin Cole, Yang Lei, Suqing Li, Rachid Mohamed, Christian Turbide, Millie Chau, Megan Howarth, Shane Cartwright, Hannah F Koury, Tamim Nashad, Zhao Wu Meng, Alejandra Tepox-Padrón, Ahmed Kayal, Emmanuel González-Moreno, Darren R Brenner, Zachary L Smith, Rajesh N Keswani, B Joseph Elmunzer, Sachin Wani, Ronald J Bridges, Robert J Hilsden, Steven J Heitman, Nauzer Forbes","doi":"10.14309/ajg.0000000000002946","DOIUrl":"https://doi.org/10.14309/ajg.0000000000002946","url":null,"abstract":"<p><strong>Introduction: </strong>Clinically significant post-endoscopic retrograde cholangiopancreatography (ERCP) bleeding (CSPEB) is common. Contemporary estimates of risk are lacking. We aimed to identify risk factors of and outcomes after CSPEB.</p><p><strong>Methods: </strong>We analyzed multicenter prospective ERCP data between 2018 and 2024 with 30-day follow-up. The primary outcome was CSPEB, defined as hematemesis, melena, or hematochezia resulting in (i) hemoglobin drop ≥ 20 g/L or transfusion and/or (ii) endoscopy to evaluate suspected bleeding and/or (iii) unplanned healthcare visitation and/or prolongation of existing admission. Firth logistic regression was used. P values <0.05 were significant, with odds ratios (ORs) and 95% confidence intervals reported.</p><p><strong>Results: </strong>CSPEB occurred after 129 (1.5%) of 8,517 ERCPs (mean onset 3.2 days), with 110 of 4,849 events (2.3%) occurring after higher risk interventions (sphincterotomy, sphincteroplasty, precut sphincterotomy, and/or needle-knife access). Patients with CSPEB required endoscopy and transfusion in 86.0% and 53.5% of cases, respectively, with 3 cases (2.3%) being fatal. P2Y 12 inhibitors were held for a median of 4 days (interquartile range 4) before higher risk ERCP. After higher risk interventions, P2Y 12 inhibitors (OR 3.33, 1.26-7.74), warfarin (OR 8.54, 3.32-19.81), dabigatran (OR 13.40, 2.06-59.96), rivaroxaban (OR 7.42, 3.43-15.24), and apixaban (OR 4.16, 1.99-8.20) were associated with CSPEB. Significant intraprocedural bleeding after sphincterotomy (OR 2.32, 1.06-4.60), but not after sphincteroplasty, was also associated. Concomitant cardiorespiratory events occurred more frequently within 30 days after CSPEB (OR 12.71, 4.75-32.54).</p><p><strong>Discussion: </strong>Risks of antiplatelet-related CSPEB may be underestimated by endoscopists based on observations of suboptimal holding before higher risk ERCP. Appropriate periprocedural antithrombotic management is essential and could represent novel quality initiative targets.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Natural History After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Population-Based Cohort Study From the United States. 溃疡性结肠炎回肠袋-肛门吻合术后的自然史:美国基于人群的队列研究。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-06-18 DOI: 10.14309/ajg.0000000000002891
Edward L Barnes, Aakash Desai, Jana G Hashash, Francis A Farraye, Gursimran S Kochhar
{"title":"The Natural History After Ileal Pouch-Anal Anastomosis for Ulcerative Colitis: A Population-Based Cohort Study From the United States.","authors":"Edward L Barnes, Aakash Desai, Jana G Hashash, Francis A Farraye, Gursimran S Kochhar","doi":"10.14309/ajg.0000000000002891","DOIUrl":"10.14309/ajg.0000000000002891","url":null,"abstract":"<p><strong>Introduction: </strong>There are limited data regarding the natural history after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). The principal objectives of this study were to identify 4 key outcomes in the natural history after IPAA within 1, 3, 5, and 10 years: the incidence of pouchitis, Crohn's-like disease of the pouch, use of advanced therapies after IPAA, and pouch failure requiring excision in a network of electronic health records.</p><p><strong>Methods: </strong>We performed a retrospective cohort study in TriNetX, a research network of electronic health records. In addition to evaluating incidence rates, we also sought to identify factors associated with pouchitis and advanced therapy use within 5 years of IPAA after 1:1 propensity score matching, expressed as adjusted hazard ratios (aHRs).</p><p><strong>Results: </strong>Among 1,331 patients who underwent colectomy with IPAA for UC, the incidence of pouchitis increased from 58% in the first year after IPAA to 72% at 10 years after IPAA. After propensity score matching, nicotine dependence (aHR 1.61, 95% confidence interval [CI] 1.19-2.18), antitumor necrosis factor therapy (aHR 1.33, 95% CI 1.13-1.56), and vedolizumab prior to colectomy (aHR 1.44, 95% CI 1.06-1.96) were associated with an increased risk of pouchitis in the first 5 years after IPAA. The incidence of Crohn's-like disease of the pouch increased to 10.3% within 10 years of IPAA while pouch failure increased to 4.1%. The incidence of advanced therapy use peaked at 14.4% at 10 years after IPAA.</p><p><strong>Discussion: </strong>The incidence of inflammatory conditions of the pouch remains high in the current era, with 14% of patients requiring advanced therapies after IPAA.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11534529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141417263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Identification of Achalasia Within Absent Contractility Phenotypes on High-Resolution Manometry: Prevalence, Predictive Factors, and Treatment Outcome. 通过高分辨率测压鉴定无收缩表型中的贲门失弛缓症:发病率、预测因素和治疗效果。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-02-01 DOI: 10.14309/ajg.0000000000002694
Parth Patel, Benjamin D Rogers, Arvind Rengarajan, Benjamin Elsbernd, Elizabeth R O'Brien, C Prakash Gyawali
{"title":"Identification of Achalasia Within Absent Contractility Phenotypes on High-Resolution Manometry: Prevalence, Predictive Factors, and Treatment Outcome.","authors":"Parth Patel, Benjamin D Rogers, Arvind Rengarajan, Benjamin Elsbernd, Elizabeth R O'Brien, C Prakash Gyawali","doi":"10.14309/ajg.0000000000002694","DOIUrl":"10.14309/ajg.0000000000002694","url":null,"abstract":"<p><strong>Introduction: </strong>Absent contractility on high-resolution manometry (HRM) defines severe hypomotility but needs distinction from achalasia. We retrospectively identified achalasia within absent contractility using HRM provocative maneuvers, barium esophagography, and functional lumen imaging probe (FLIP).</p><p><strong>Methods: </strong>Adult patients with absent contractility on HRM during the 4-year study period were eligible for inclusion. Inadequate studies, achalasia after therapy, or prior foregut surgery were exclusions. Upright integrated relaxation pressure (IRP) >12 mm Hg, panesophageal pressurization, and/or elevated IRP on multiple rapid swallows and rapid drink challenge (RDC) were considered abnormal. Esophageal barium retention and abnormal esophagogastric junction distensibility index (<2.0 mm 2 /mm Hg) on FLIP defined achalasia. Clinical, endoscopic, and motor characteristics of patients with achalasia were compared with absent contractility without obstruction.</p><p><strong>Results: </strong>Of 164 patients, 20 (12.2%) had achalasia (17.9% of 112 patients with adjunctive testing), while 92 did not, and 52 did not undergo adjunctive tests. Achalasia was diagnosed regardless of IRP value, but the median supine IRP was higher (odds ratio 1.196, 95% confidence interval 1.041-1.375, P = 0.012). Patients with achalasia were more likely to present with dysphagia (80.0% vs 35.9%, P < 0.001), with obstructive features on HRM maneuvers (83.3% vs 48.9%, P = 0.039), but lower likelihood of GERD evidence (20.0% vs 47.3%, P = 0.027) or large hiatus hernia (15.0% vs 43.8%, P = 0.002). On multivariable analysis, dysphagia presentation ( P = 0.006) and pressurization on RDC ( P = 0.027) predicted achalasia, while reflux and presurgical evaluations and lack of RDC obstruction predicted absent contractility without obstruction.</p><p><strong>Discussion: </strong>Despite HRM diagnosis of absent contractility, achalasia is identified in more than 1 in 10 patients regardless of IRP value.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Response to Menon. 回应梅农。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-10-09 DOI: 10.14309/ajg.0000000000003054
Silke Leonhardt, Christian Jürgensen
{"title":"Response to Menon.","authors":"Silke Leonhardt, Christian Jürgensen","doi":"10.14309/ajg.0000000000003054","DOIUrl":"10.14309/ajg.0000000000003054","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Continuing Medical Education Questions: November 2024. 继续医学教育问题:2024 年 11 月。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-07-05 DOI: 10.14309/ajg.0000000000003114
Shanti L Eswaran
{"title":"Continuing Medical Education Questions: November 2024.","authors":"Shanti L Eswaran","doi":"10.14309/ajg.0000000000003114","DOIUrl":"10.14309/ajg.0000000000003114","url":null,"abstract":"<p><p>Article Title: Risk of Pancreatitis After Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Pancreatic Cystic Lesions: A Systematic Review and Meta-Analysis.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Joint Hypermobility, Autonomic Dysfunction, Gastrointestinal Dysfunction, and Autoimmune Markers: Clinical Associations and Response to Intravenous Immunoglobulin Therapy. 关节过度活动、自主神经功能障碍、胃肠道功能障碍和自身免疫标记物(JAG-A):临床关联和对静脉注射免疫球蛋白疗法的反应。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-06-24 DOI: 10.14309/ajg.0000000000002910
Pankaj J Pasricha, Megan McKnight, Luisa Villatoro, Guillermo Barahona, Jeffrey Brinker, Ken Hui, Michael Polydefkis, Robert Burns, Zsuzsanna H McMahan, Neda Gould, Brent Goodman, Joseph Hentz, Glenn Treisman
{"title":"Joint Hypermobility, Autonomic Dysfunction, Gastrointestinal Dysfunction, and Autoimmune Markers: Clinical Associations and Response to Intravenous Immunoglobulin Therapy.","authors":"Pankaj J Pasricha, Megan McKnight, Luisa Villatoro, Guillermo Barahona, Jeffrey Brinker, Ken Hui, Michael Polydefkis, Robert Burns, Zsuzsanna H McMahan, Neda Gould, Brent Goodman, Joseph Hentz, Glenn Treisman","doi":"10.14309/ajg.0000000000002910","DOIUrl":"10.14309/ajg.0000000000002910","url":null,"abstract":"<p><strong>Introduction: </strong>We examined autoimmunity markers (AIM) and autonomic dysfunction in patients with chronic neurogastroenterological symptoms and their relationship to joint hypermobility/hypermobility spectrum disorder (JH/HSD).</p><p><strong>Methods: </strong>AIM positivity was defined as a diagnosis of known autoimmune/autoinflammatory disorder with at least 1 positive seromarker of autoimmunity or at least 2 positive seromarkers by themselves. Three cohorts were studied: (i) retrospective (n = 300), (ii) prospective validation cohort (n = 133), and (iii) treatment cohort (n = 40), administered open-label intravenous immunoglobulin (IVIG).</p><p><strong>Results: </strong>AIM positivity was found in 40% and 29% of the retrospective and prospective cohorts, the majority of whom (71% and 69%, respectively) had autoinflammatory disorder. Significantly more patients with AIM had elevations of C-reactive protein (31% vs 15%, P < 0.001) along with an increased proportion of cardiovascular autonomic dysfunction (48% vs 29%; P < 0.001), small fiber neuropathy (20% vs 9%; P = 0.002), and HLADQ8 positivity (24% vs 13%, P = 0.01). Patients with JH/HSD were more likely to have AIM (43% vs 15%, P = 0.001) along with more severe autonomic and gastrointestinal (GI) symptom scores. IVIG treatment was associated with robust improvement in pain, GI, and autonomic symptoms, but adverse events were experienced by 62% of patients.</p><p><strong>Discussion: </strong>Autoimmune markers and autonomic dysfunction are common in patients with unexplained GI symptoms, especially in those with JH/HSD. Many patients seem to respond to IVIG treatment, but this needs to be confirmed by controlled trials. These results highlight the need for vigilance for autoimmune and autonomic factors and JH/HSD in patients with neurogastroenterological disorders. Clinicaltrials.gov , NCT04859829.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endoscopic Retrograde Cholangiopancreatography in COVID-Associated Cholangiopathy. COVID相关性胆管病的内镜逆行胰胆管造影术
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-07-31 DOI: 10.14309/ajg.0000000000002932
Shyam Menon
{"title":"Endoscopic Retrograde Cholangiopancreatography in COVID-Associated Cholangiopathy.","authors":"Shyam Menon","doi":"10.14309/ajg.0000000000002932","DOIUrl":"10.14309/ajg.0000000000002932","url":null,"abstract":"","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141854499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
No Effect of Methylnaltrexone on Acute Pancreatitis Severity: A Multicenter Randomized Controlled Trial. 甲基纳曲酮对急性胰腺炎严重程度无影响:一项多中心随机对照试验
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI: 10.14309/ajg.0000000000002904
Cecilie Siggaard Knoph, Mathias Ellgaard Cook, Srdan Novovic, Mark Berner Hansen, Michael Bau Mortensen, Liv Bjerre Juul Nielsen, Irene Maria Høgsberg, Celina Salomon, Celine Emilie Lindqvist Neergaard, Aseel Jabbar Aajwad, Sanjay Pandanaboyana, Lone Schmidt Sørensen, Ole Thorlacius-Ussing, Jens Brøndum Frøkjær, Søren Schou Olesen, Asbjørn Mohr Drewes
{"title":"No Effect of Methylnaltrexone on Acute Pancreatitis Severity: A Multicenter Randomized Controlled Trial.","authors":"Cecilie Siggaard Knoph, Mathias Ellgaard Cook, Srdan Novovic, Mark Berner Hansen, Michael Bau Mortensen, Liv Bjerre Juul Nielsen, Irene Maria Høgsberg, Celina Salomon, Celine Emilie Lindqvist Neergaard, Aseel Jabbar Aajwad, Sanjay Pandanaboyana, Lone Schmidt Sørensen, Ole Thorlacius-Ussing, Jens Brøndum Frøkjær, Søren Schou Olesen, Asbjørn Mohr Drewes","doi":"10.14309/ajg.0000000000002904","DOIUrl":"10.14309/ajg.0000000000002904","url":null,"abstract":"<p><strong>Introduction: </strong>Opioids used to manage severe pain in acute pancreatitis (AP) might exacerbate the disease through effects on gastrointestinal and immune functions. Methylnaltrexone, a peripherally acting µ-opioid receptor antagonist, may counteract these effects without changing analgesia.</p><p><strong>Methods: </strong>This double-blind, randomized, placebo-controlled trial included adult patients with AP and systemic inflammatory response syndrome at 4 Danish centers. Patients were randomized to receive 5 days of continuous intravenous methylnaltrexone (0.15 mg/kg/d) or placebo added to the standard of care. The primary end point was the Pancreatitis Activity Scoring System score after 48 hours of treatment. Main secondary outcomes included pain scores, opioid use, disease severity, and mortality.</p><p><strong>Results: </strong>In total, 105 patients (54% men) were randomized to methylnaltrexone (n = 51) or placebo (n = 54). After 48 hours, the Pancreatitis Activity Scoring System score was 134.3 points in the methylnaltrexone group and 130.5 points in the placebo group (difference 3.8, 95% confidence interval [CI] -40.1 to 47.6; P = 0.87). At 48 hours, we found no differences between the groups in pain severity (0.0, 95% CI -0.8 to 0.9; P = 0.94), pain interference (-0.3, 95% CI -1.4 to 0.8; P = 0.55), and morphine equivalent doses (6.5 mg, 95% CI -2.1 to 15.2; P = 0.14). Methylnaltrexone also did not affect the risk of severe disease (8%, 95% CI -11 to 28; P = 0.38) and mortality (6%, 95% CI -1 to 12; P = 0.11). The medication was well tolerated.</p><p><strong>Discussion: </strong>Methylnaltrexone treatment did not achieve superiority over placebo for reducing the severity of AP.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141445280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early Diagnostic Paracentesis Improves Outcomes of Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis. 早期诊断性腹腔穿刺术可改善肝硬化腹水住院患者的预后:系统回顾与元分析》。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-06-25 DOI: 10.14309/ajg.0000000000002906
Azizullah Beran, Mouhand F H Mohamed, Alejandra Vargas, Tarek Aboursheid, Muhammad Aziz, Ruben Hernaez, Kavish R Patidar, Lauren D Nephew, Archita P Desai, Eric Orman, Naga Chalasani, Marwan S Ghabril
{"title":"Early Diagnostic Paracentesis Improves Outcomes of Hospitalized Patients With Cirrhosis and Ascites: A Systematic Review and Meta-Analysis.","authors":"Azizullah Beran, Mouhand F H Mohamed, Alejandra Vargas, Tarek Aboursheid, Muhammad Aziz, Ruben Hernaez, Kavish R Patidar, Lauren D Nephew, Archita P Desai, Eric Orman, Naga Chalasani, Marwan S Ghabril","doi":"10.14309/ajg.0000000000002906","DOIUrl":"10.14309/ajg.0000000000002906","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnostic paracentesis is recommended for patients with cirrhosis admitted to the hospital, but adherence is suboptimal with unclear impact on clinical outcomes. The aim of this meta-analysis was to assess the outcomes of early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites.</p><p><strong>Methods: </strong>We searched multiple databases for studies comparing early vs delayed diagnostic paracentesis among hospitalized patients with cirrhosis and ascites. The pooled odds ratio (OR) and mean difference with confidence intervals (CIs) for proportional and continuous variables were calculated using the random-effects model. Early diagnostic paracentesis was defined as receiving diagnostic paracentesis within 12-24 hours of admission. The primary outcome was in-hospital mortality. Secondary outcomes were length of hospital stay, acute kidney injury, and 30-day readmission.</p><p><strong>Results: </strong>Seven studies (n = 78,744) (n = 45,533 early vs n = 33,211 delayed diagnostic paracentesis) were included. Early diagnostic paracentesis was associated with lower in-hospital mortality (OR 0.61, 95% CI 0.46-0.82, P = 0.001), length of hospital stay (mean difference -4.85 days; 95% CI -6.45 to -3.20; P < 0.001), and acute kidney injury (OR 0.62, 95% CI 0.42-0.92, P = 0.02) compared with delayed diagnostic paracentesis, with similar 30-day readmission (OR 1.11, 95% CI 0.52-2.39, P = 0.79). Subgroup analysis revealed consistent results for in-hospital mortality whether early diagnostic paracentesis performed within 12 hours (OR 0.51, 95% CI 0.32-0.79, P = 0.003, I2 = 0%) or within 24 hours of admission (OR 0.67, 95% CI 0.45-0.98, P = 0.04, I2 = 82%). Notably, the mortality OR was numerically lower when diagnostic paracentesis was performed within 12 hours, and the results were precise and homogenous ( I2 = 0%).</p><p><strong>Discussion: </strong>Findings from this meta-analysis suggest that early diagnostic paracentesis is associated with better patient outcomes. Early diagnostic paracentesis within 12 hours of admission may be associated with the greatest mortality benefit. Data from large-scale randomized trials are needed to validate our findings, especially if there is a greater mortality benefit for early diagnostic paracentesis within 12 hours.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141445279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Healthcare Resource Utilization and Costs Associated With Eosinophilic Esophagitis Among Commercially Insured Patients in the United States. 美国商业保险患者中与嗜酸性粒细胞食管炎相关的医疗资源利用率和成本。
IF 8 1区 医学
American Journal of Gastroenterology Pub Date : 2024-11-01 Epub Date: 2024-06-24 DOI: 10.14309/ajg.0000000000002901
Qian Xia, Tom Tencer, Greeta Jobson, Ellen Qian, Evan S Dellon, Mousumi Biswas
{"title":"Healthcare Resource Utilization and Costs Associated With Eosinophilic Esophagitis Among Commercially Insured Patients in the United States.","authors":"Qian Xia, Tom Tencer, Greeta Jobson, Ellen Qian, Evan S Dellon, Mousumi Biswas","doi":"10.14309/ajg.0000000000002901","DOIUrl":"10.14309/ajg.0000000000002901","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate real-world healthcare resource utilization (HCRU) and costs associated with eosinophilic esophagitis (EoE) in the United States.</p><p><strong>Methods: </strong>Retrospective case-control cohort analysis of Optum Clinformatics claims data (January 2008-September 2020) comparing unadjusted and adjusted HCRU (visits per 1,000 patients per month) and all-cause costs (per patient per month).</p><p><strong>Results: </strong>Patients with EoE incurred significantly higher monthly HCRU (adjusted Δ [95% confidence interval]: inpatient visits, 2.8 [0.1-4.0]; emergency department visits, 14.7 [4.3-32.1]; outpatient visits, 388.8 [362.1-418.0]); and costs ($581 [$421-$600]) vs matched controls (all P < 0.001).</p><p><strong>Discussion: </strong>EoE imposes substantial economic burden. More effective and targeted treatments that improve outcomes for patients are needed.</p>","PeriodicalId":7608,"journal":{"name":"American Journal of Gastroenterology","volume":null,"pages":null},"PeriodicalIF":8.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141615752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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